Project Summary Obstructive sleep apnea (OSA) is a vascular risk factor that can lead to development of diabetes mellitus and cardiovascular disease (CVD). Importantly, OSA is highly prevalent in Latinos, who have more than a 2-fold risk of diabetes and CVD compared to non-Hispanic whites; disparities that motivated this R21 application. Treatment of OSA has not consistently reduced cardiovascular risk in clinical trials, results partly explained by suboptimal adherence to positive airway pressure therapy. Alternatively, identifying the subset of individuals who respond more favorably to OSA therapy can lead to personalized care and greater reduction in CVD. Of interest, OSA phenotypes have been described using data-driven analytical methods, such as cluster analysis, allowing evaluation of distinct groups of OSA patients at higher risk for CVD. Importantly, OSA phenotypes have not been described in Latinos, who have a large burden of diabetes and CVD. In addition, most studies are comprised of middle-aged males from clinical centers, which could introduce selection bias. Hence, there is a gap of prospective population based studies that can advance our understanding of OSA phenotypes and CVD risk, especially in a large and diverse sample of Latinos. Sleep apnea phenotypes in Latinos (SLEPT) evaluate OSA phenotypes in a large population-based cohort of U.S. Latinos. We efficiently leveraged the baseline and second- wave data of the Hispanic Community Health Study/Study of Latinos (SOL; N=16,415). SOL provides extensive and detailed data on sociocultural, genetic, and cardiovascular risk factors. At baseline (2008-2011), SOL obtained home-sleep test in over 16,000 participants and sleep habits through questionnaires and actigraphy, in a subsample of 2,252 SOL participants. In this exploratory study, we propose to analyze the sleep and cardiovascular measures obtained at SOL Visit 1 and new emerging data, obtained during follow-up in visit 2 (years 2014-2017). SLEPT will define the sleep phenotypes associated to early cardiovascular risk; provide preliminary data for polysomnography in future studies and identify at-risk individuals for sleep interventions and CVD outcomes in SOL. Therefore we aim to 1) identify OSA phenotypes across age, sex and Latino groups and 2) determine which phenotypes associates with prevalent and incident diabetes mellitus and CVD. By year 2060, 29% of the U.S. population will be Latino. However, there is no information about the OSA phenotypes that prospectively associate with CVD risk in Latinos. SLEPT will address the factors that explain within Latino differences in sleep, diabetes and CVD; in addition to Latino health disparities when compared to other U.S. demographic groups. This study is responsive to Healthy People 2020 goals and the NIH/NHLBI workshop on Personalized Medicine and Hispanic Health.